A Comparative Study Between Simulation-based and Problem-based Learning in Difficult Airway Management Workshop

Introduction Currently, teachers have emphasized the instructional strategies and enthusiasm in critical thinking to students to understand the educational course1. As coaching mentors, they search for innovative teaching models to reach the learning target 2. In anesthesia, a training program of nurse students involves several teaching methods such as seminars, journal clubs as well as topic, didactic, simulation and problem-based learning 13, 14.

Simulation-based learning in medicine utilizes aides such as manikins or actors to replicate clinical scenarios. It yields the acquisition of skills through deliberate practice rather than an apprentice style of learning 22. However, problem-based learning is a small group discussions where students are active, learner-centered, or self-directed learning to the topic assignments. Teachers play role as moderators or facilitators 21.

Teaching and learning in airway management are essential in anesthetic field. The personnel need to be keen both basic and advance knowledge owing to its applications to the benefits of patients' life. At present, the diversity of learning techniques (PBL and SBL) allows sophisticated devices as an interactive learning tool to cope with all difficulties in details.

Nevertheless, neither PBL nor SBL manifests the superior benefit of instructional process and learning content xx. Chin KL, et al. (2014) concluded that simulation was superior to case-based learning in teaching diabetic ketoacidosis and thyroid storm to the final-year, undergraduate pharmacy students. Randolph H, et al. (2006) revealed that students who learned critical assessment and management skills using full-scale, high- fidelity simulation, performed better than students who acquired similar skills in an interactive problem-based learning format.

As either PBL or SBL on difficult airway management is based upon the same table of specifications and experienced instructors. We would like to compare the teachers' and students' attitudes on these two learning methods.

Objectives To compare between PBL and SBL in terms of learning content, instructional and evaluation methods

Material and Methods After IRB approval No. 369/2558(EC3). A prospective, questionnaires-based study was performed amongst 40 volunteered, consent-signed nurse anesthetist students. The inclusion criteria for teachers were anesthesiologists who have involved in SBL and PBL with more than 3 years of experience in teaching. The inclusion criteria for students were nurse anesthetist students in the academic years of 2015. The exclusion criteria of both groups were ones who did not fit all qualifications.

After stratified randomization, ten nurse anesthetist students attended either SBL or PBL course one at a time. The one-day workshops were performed simultaneously. Six weeks later, a crossover technique was applied for both groups. At the end of project, teachers and students had to response to Likert's scale questionnaires: 4 = very suitable, 3 = suitable, 2 = unsuitable, 1 = very unsuitable.

The teachers' questionnaire based on table of specification of the learning contents, consisted of 4 parts: airway evaluation (history taking and physical examination), patient preparation (equipments and experienced helpers), 5 strategic planning (facemask ventilation, supraglottic airway device, laryngoscopy, tracheal intubation and failed intubation) and follow up care (documentation and informative advice).

On the other hand, the students' questionnaires comprised 3 parts: learning content, process and evaluation.

The correctness and appropriateness of the questionnaires (content validity) were determined by three board-certified anesthesiologists who had at least ten year experiences in anesthesia and were not involved in the project. The tryout was performed by ten novice nurse anesthetists and five anesthesiologists on students' and teachers' matters respectively. The index of item objective congruence was 0.80 and 0.82 with Cronbach's Alpha of 0.97 and 0.92 respectively. We used percentage, mean, standard deviation and student t-Test for data analysis at the significant level of 0.05 with 95% confident interval.